Genital regeneration and stem cell medicine

Regenerating tissues through the implantation of growth factors (PRP) and adipose tissue derivatives (micro, nanofat, graft fat, and stromal fraction) is the goal of regenerative medicine and surgery. It is a chapter of immense fascination, relevance, and significant prospects.

Prp

Indications

Dryness/senescence/need for regeneration

Surgical Technique

Blood withdrawal, appropriate treatment of the same, injection with a very fine needle into the vulva and/or vagina.

Procedure

40 minutes

Complications

Extremely rare

Postoperative Pain

no

Recovery

immediate

Nanofatgraft

Indications

dryness/senescence/need for regeneration

Technique

sampling of adipose tissue, appropriate treatment of the same, injection with a fine needle into the vulva and/or vagina

Procedure

40 minutes

Pain

rare

Complications

Extremely rare

Recovery

immediate

Femifill® vulvar for lichen sclerosis

Indications

dryness/senescence/need for regeneration/loss of volume

Surgical Technique

sampling of adipose tissue, appropriate treatment of the same, multilayer implantation of different adipose preparations + vulvar co2 laser

Procedure

60 /90 minutes

Complications

rare (infections, hematomas)

Postoperative Pain

poor if common painkillers are used

Recovery

2/4 weeks

Full vulvo vaginal femifill®

Indications

dryness/senescence/need for regeneration/loss of volume

Technique

sampling of adipose tissue, appropriate treatment of the same, multilayer implantation of different adipose preparations + endovaginal and vulvar CO2 laser

Procedure

60 /90 minutes

Pain

poor if common painkillers are used

Complications

rare (infections, hematomas)

Recovery

2/4 weeks

Prp and vulvar aging

Platelet-Rich Plasma (PRP) is a blood fraction obtained by processing peripheral blood through centrifugation with the addition of an anticoagulant. PRP is easily collected, prepared, and injected. It can be injected with extremely fine needles. PRP contains growth factors with neoangiogenic and regenerative capabilities. Its ability is to induce other cells to activate, acting as an activator and accelerator of healing processes. The quality of PRP is closely related to the equipment used. It has been shown that there are machines on the market capable of providing extremely poor concentrations of PRP, while others offer a high-quality product. The quantity of PRP injected is also relevant because it has been demonstrated that too low a quantity does not induce regeneration, and too high a quantity blocks it. In recent years, many authors have proposed mixing adipose tissue with platelet-rich plasma. This procedure can potentially increase the engraftment of adipose tissue. PRP can be useful for treating mucosal and cutaneous surface pathologies as it can be injected with thin needles, even within the dermis.

Cellular anatomy and properties

Adipose tissue is composed of a multitude of cells: mature adipocytes (large fat cells), immature adipocytes (small fat cells destined to become large), and fibroblasts. The cells are held in place by a network of collagen and elastic fibers within which blood vessels, nerve endings, cells of the blood component, and cells of the stromal fraction are present. Among these, endothelial cells, preadipocytes, and stem cells should be mentioned, which are totipotent cells capable of transforming into any cell type. Many cells of the stromal fraction have very high regenerative capabilities due to the secretion of growth factors and the production of factors capable of modulating inflammatory, immune, and more generally neoangiogenic processes. Only recently have additional capabilities of these cell populations, such as pain control, been defined.

Adipose tissue

Autologous regenerative cellular preparations (from the same person) for injection can be profoundly different from each other. The generic term used is lipofilling or lipofilling, but this term does not precisely specify a specific procedure. Scientifically, we distinguish three categories of adipose tissue implants based on the size of the lipocitary-derived cells:

  1. Nanofatgraft: It does not contain adipocytes but only the stromal fraction mixed with triglycerides.
  2. Microfatgraft: It contains clusters (groups) of very small cells with a greater engraftment and activation capacity.
  3. Fatgraft: It is the traditional lipofilling codified by Sydney Coleman and involves the implantation of adipose tissue taken and centrifuged.

Today, it is known that the effectiveness of the treatment is closely connected to the method of harvesting, treatment, and implantation. Small cellular clusters, maximum delicacy in treatment, maximum sterility, and implantation with small cannulas are the basis of treatment effectiveness.

Fake stem cell drug dealers are pilloried

Although it is true that adipose tissue contains stem cells, their concentration is extremely low compared to other cell populations. It is possible to extract stem cells and multiply them. However, this process is extremely lengthy, very expensive, and subject to very strict ministerial regulations. Preparations of pure stem cells can be used exclusively in an experimental and controlled environment. It follows that anyone claiming to inject stem cells is doing so for commercial rather than scientific purposes. It is correct to assert that cellular populations of adipose origin, which also contain stem cells, are used. It is not the same as saying that stem cells are implanted.

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